- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.63 / $767.63 / $767.63
| Facility | | $767.63 | $767.63 | $767.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.63 / $767.63 / $996.77
| Professional | | $767.63 | $767.63 | $996.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,057.94 / $1,163.74 / $1,175.49
| Professional | | $1,057.94 | $1,163.74 | $1,175.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.15 / $1,324.08 / $1,324.08
| Facility | | $752.15 | $1,324.08 | $1,324.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.01 / $1,546.71 / $2,041.75
| Professional | | $1,288.01 | $1,546.71 | $2,041.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.97 / $1,320.21 / $6,344.91
| Facility | | $693.97 | $1,320.21 | $6,344.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.28 / $600.52 / $1,000.86
| Professional | | $458.28 | $600.52 | $1,000.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.21 / $1,324.08 / $1,828.61
| Facility | | $1,320.21 | $1,324.08 | $1,828.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.84 / $1,586.91 / $2,727.81
| Professional | | $1,198.84 | $1,586.91 | $2,727.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.37 / $600.52 / $903.69
| Professional | | $435.37 | $600.52 | $903.69 |